Cost impact of introducing a treatment escalation/limitation plan during patients’ last hospital admission before death

Bouttell, J. , Gonzalez, N., Geue, C. , Lightbody, C. J. and Taylor, D. R. (2020) Cost impact of introducing a treatment escalation/limitation plan during patients’ last hospital admission before death. International Journal for Quality in Health Care, 32(10), pp. 694-700. (doi: 10.1093/intqhc/mzaa132) (PMID:33210722)

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223688.pdf - Accepted Version



Objective: A recent study found that the use of a treatment escalation/limitation plan (TELP) was associated with a significant reduction in non-beneficial interventions (NBIs) and harms in patients admitted acutely who subsequently died. We quantify the economic benefit of the use of a TELP. Design: NBIs were micro-costed. Mean costs for patients with a TELP were compared to patients without a TELP using generalized linear model regression, and results were extrapolated to the Scottish population. Setting: Medical, surgical and intensive care units of district general hospital in Scotland, UK. Participants: Two hundred and eighty-seven consecutive patients who died over 3 months in 2017. Of these, death was ‘expected’ in 245 (85.4%) using Gold Standards Framework criteria. Intervention: Treatment escalation/limitation plan. Main Outcome Measure: Between-group difference in estimated mean cost of NBIs. Results: The group with a TELP (n = 152) had a mean reduction in hospital costs due to NBIs of GB £220.29 (US $;281.97) compared to those without a TELP (n = 132) (95% confidence intervals GB £323.31 (US $413.84) to GB £117.27 (US $150.11), P = <0.001). Assuming that a TELP could be put in place for all expected deaths in Scottish hospitals, the potential annual saving would be GB £2.4 million (US $3.1 million) from having a TELP in place for all ‘expected’ deaths in hospital. Conclusions: The use of a TELP in an acute hospital setting may result in a reduction in costs attributable to NBIs.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Bouttell, Dr Janet and Geue, Dr Claudia
Authors: Bouttell, J., Gonzalez, N., Geue, C., Lightbody, C. J., and Taylor, D. R.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
Journal Name:International Journal for Quality in Health Care
Publisher:Oxford University Press
ISSN (Online):1464-3677
Published Online:18 November 2020
Copyright Holders:Copyright © The Author(s) 2020
First Published:First published in International Journal for Quality in Health Care 32(10):694-700
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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